messy procedural soup before you can get to that final package. and he seems to be gung ho about doing it and we'll certainly have to see. >> it sounds like they still don't have a time line for when this comes to the floor in both the house and the senate. >> speaker pelosi spoke on this as well and she did not lay out a precise day to day timetable although the political advisers are eeg tore get this done by prig so they can move towards jobs and reelection is what they're talking about. >> on jobs, what did you hear? >> it sounds like there's a split right now where house democratic leadership and george mill ser a part of the leader shrp, are fine with having a series of bills, whatever can get through senate they want to start claiming some victories. but the reality is a lot of rank and file members, especially liberal members, members who really care about

all the transportation needs, they tend to want bigger items that do more. they don't just want to have some things they can declare victory on. and it's not clear that those thing ks get through the senate. so there's a real problem here for democrats in trying to deal wpt objects. they might be able to pass some of the small things, but serble not a lot of happy members because a lot of things they want so far can't get through the senate. >> what are you hearing about which comes first in the next month, jobs or health care or a combination of both? >> i think you'll see jobs. there's going to be some kind of jobs package passed in the next few days. they're going to keep passing jobs packageses. they're already passing things over the weekend. little teeny tiny bits are going to go. this is not going to be like the stimulus package or this one big thing. it's going to be a transportation piece. it's going to be a cobra, unemployment piece. there's going to be various

pieces moving. and that's basically because that's all you can get through the senate. they seemed to have learned something at the leadership level at the house and the senate that small ball works. it's very hard for republicans to say i don't want people to get unemployment insurance. you saw just one senator, jim bunning, the retiring senate from kentucky, willing to filibuster that as a one-man filibuster. but the reality is all the other republicans were willing to let it go because it's very politically difficult to fight one thing. if it's a bigger package, it's a lot easier to do. and the democrats are starting to learn that. that's why you're starting to see these smaller bills. >> one final note about charlie rangel and what chairman miller had to say about his fellow chairman and colleague. they've been in the house together a long time. >> i was struck he wasn't overly enthuseyass tick about defending rangle's behavior.

what he was pretty clear saying politically better for democrat fs rangle went ahead and stepped down from the chairmanship if not from his seat in congress. that's what i thought he implid. but at the same time, the members know that rangle has been in congress a very long time, kind of historic member in his district. and i think it would be hard for him to step aside from that job. so you see that tension in the way miller was discussing the subject. >> we'll have to leaf it there. thank you both for being on "newsmakers." >> thank you. >> i come from latin america. i'm accustomed to seeport. i was never expecting to see this kind of poverty in the capitol of the u.s. >> on a different side of the nation's capital. in the shadow of power. tonight on c-span's q and a. >> the new c-span video library is a digital archive of c-span's programming. from barack obama to ronald

reagan and everyone in between. over 157,000 hours of c-span video now available to you. it's fast and free. try it out at c-span video.org. >> on thursday, congressional democrats and republicans gathered at blair house across the street from the white house for a discussion on health care with president obama. the president announced the idea for this event during a super bowl sunday interview with cbs news anchor katie curic. since then he has released a health care plan drawing largely from two bills passed by house and senate democrats. we'll show you the entire day-long session beginning with opening comments from the president and congressional leaders followed by discussions on health care costs, insurance reforms, deficit reduction, and expanding coverage. this morning's session is just under three hours. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010]

>> everybody please have a seat. come on, biden. good morning, everybody. welcome. thank you so much for participating today. i am very grateful to all of you, because i know how busy you are. what i want to do is just make a few brief remarks on the front end, and then we are going to allow leadership from both the house and senate to make some opening remarks. and then we will dive in.

last year, obviously, was one of the toughest years we've had on record. and all of us in one way or another, were devoted to focusing on breaking the back of the recession. restoring economic growth. putting people back to work. we have still got a long way to go. and so i know both the house and the senate are interested in how do we propel economic growth forward, how do we create more jobs. i was very pleased to see a glimpse of bipartisanship in the senate recently in passing a jobs bill, and i hope that continues, and i know there will be some additional pieces of legislation moving forward around, for example, making sure the small businesses can get financing. and those are the kinds of things that i think all parties and both chambers should be able to agree to. so i'm very much looking forward to working with you on all those issues. i have said repeatedly. i said at the state of the

union, and i said last night, when i was meeting with the business round table, that in addition to dealing with the immediate challenges we face in the recovery, it's absolutely critical that we also look at some fundamental structural problems in our economy that are hurting families, hurting businesses, and having an impact on the exploding deficits and debts that the federal government but also state governments are carrying. and it's for that reason that last year, around this time, actually, i hosted in the white house a health care summit and indicated to congress that it was absolutely critical for us to begin now moving on what is one of the biggest dregs on our economy and represents one of the biggest hardships that families face. some of you know that i get ten

letters out of the 40,000 that i receive every day for me to take upstairs to the residence and read every single night. and these are letters from all across the country, constituents from every walk of life. and i can tell you that at least two, sometimes five of the ten letters, relates to the challenges that people are experiencing in health care every single day. i'll get letters from parents whose children have preexisting conditions and maybe those children were able to get health insurance when they were young, but now they're grown up, about to move out, and can't get insurance no matter what job they find. i hear from small businesses who have just opened up their new rates from their insurance company, and it turns out that their race have gone up 20, 30, in some cases 35%. i hear from families who have

hit lifetime limits, and because somebody in their family is very ill, at a certain point, they start having to dig out of pocket, and they are having to mortgage their house and in some cases have gone bankrupt because of health care. so this is an issue that is affecting everybody. it's affecting not only those without insurance, but it's affecting those with insurance. and when you talk to every single expert, and you just talk to ordinary people and you talk to businesses, everybody understands that the problem is not getting better, it's getting worse. right now, it's projected that premiums for families with health insurance, not people without health insurance, but with health insurance, will almost certainly double over the next decade, just as they have

doubled over the past decade. in the individual markets, it's even worse. of businesses are having to make decisions about just dropping coverage all together for their employees. if they're not doing that, then the money they are spending on health care is money that otherwise could have gone to job creation. and i don't mean to tell people here about the effects on the federal budget. you know, we have got some people who have been working a very long time on figuring out how can we control the huge expansion of entitlements. almost all of the long-term deficit and debt that we face relates to the exploding costs of medicare and medicaid. almost all of them. and that is the -- that is the single-biggest driver of our federal deficit. and if we don't get control over that, we can't get control over our federal budget. now, i'm telling all of you things you already know.

maybe more personally, i should just mention the fact that i now have about as good health care as anybody could have. i've got a doctor right downstairs. and all of us when i was in the senate, and all of you as house and senate members have good health care. but remember maybe when you were younger, when you were first starting off? i can certainly remember malia coming into the kitchen one day and saying, "i can't breathe, daddy." and us having to rush her to the emergency room because she had asthma. or sasha, when she was a baby, getting meningitis and getting a spinal tap and being on antibiotics for three days and us not knowing whether or not she was going to emerge okay. in each of those instances, i remember thinking while sitting in the emergency room, what would have happened if i didn't

have reliable health care? my mother, who was self-employed, didn't have reliable health care. and she died of ovarian cancer. and there's probably nothing that modern medicine could have done about that. it was caught late. and that's a hard cancer to diagnose. but i do remember the last six months of her life, insurance companies threatening that they would the no reimburse her for her costs, and her having to be on the phone in the hospital room arguing with insurance companies when what she should have been doing is spending time with her family. i do remember that. now, everybody here has those same stories somewhere in their lives. everybody here understands the desperation that people feel when they're sick. and i think everybody here is

profoundly sympathic and wants to make sure that we have a system that works for all americans. you know, i was looking through some of past statements that people have made. and i think this concern is bipartisan.@@@@@@@@ryá@ @ @ @ @ part partnered with ted kennedy. you said that small businesses in your home state are finding it impossible to find health care coverage for your employees and the current system is in critical condition. mitch, you've had said that the need for reform is not in question. and obviously there's some statements on the democratic side as well. in question. and obviously, there are

comparable statements on the democratic side, as well. so here's the bottom line. we all know this is urgent. and unfortunately, over the course of the year, despite all of the hearings that took place and all of the negotiations that took place, and people on both sides of the aisle worked long and hard on this issue. you know, this became a very ideological battle. it became a very partisan battle. and politics, i think, ended up trumping practical common sense. you know, i said at the state of the union, and i'll repeat, i didn't take this on because i thought it was good politics. this is such a complicated issue that it's inevitably going to be contentious. but what i'm hoping to accomplish today is for everybody to focus not just on

where we differ, but focus on where we agree. because there actually is some significant agreement on a host of issues. now, i've looked very carefully at john boehner's plan that he put forward. i've looked at, you know, tom co burn and senator byrd's plan that's been put out there. paul ryan has discussed some of the issues surrounding medicare. i've looked at those very carefully. you know, mike enzi, in the past, you have put forward legislation around small businesses that are very important. and so when i look at the ideas that are out there, there is overlap. it's not perfect overlap. it's not 100% overlap. but there is some overlap. now, what i did, what the white

house did several days ago, was we posted what we think is the best blend of the house and the senate legislation that's already passed. the basic concept is that we would set up an exchange, meaning a place where individuals and small businesses could go and is get choice and competition for private health care plans, the same way that members of congress get choice and competition for their health care plans. for people who couldn't afford it, we would provide them some subsidies. but because people would have some pooling power, the costs overall would be lower, because they would be in a stronger position to negotiate. we think it is a plan that works with the existing system, the employer-based system.

the private health care system. but allows a lot of people who currently don't have health care to get health care. more importantly, for the vast majority of people who do have some health care, it allows them to get a better deal. we also have some insurance reforms in it there, that, for example, prohibit people who have preexisting conditions from being banned from getting coverage. we also talk about how we can help to make the medicare system more effective and provide better quality care. in each of those cases, there are corresponding ideas on the republican side that we should be able to bridge. so i promise not to make a long speech. let me just close by saying this. my hope in the several hours that we're going to be here today, that in each section that

we're going to discuss, how do we lower costs for families and small businesses, how do we make sure that the insurance market works for people, how do we make sure that we are dealing with the long-term deficits, how do we make sure that people who don't have coverage can get coverage. in each of those areas, what i'm going to do, i'm going to start off by saying, here's some things we agree on. and then let's talk about some areas where we disagree and see if we can bridge those gaps. i don't know that those gaps can be bridged. and it may be that at the end of the day, we come out here and everybody says, well, you know, we have some honest disagreements. people are sincere in wanting to help, but they've got different ideas about how to do it. and we can't bridge the gap between democrats and republicans on this. but i would like to make sure that this discussion is actually a discussion. and not just us trading talking

points. i hope that this isn't political feeder, where we're talking to the cameras and criticizing each other, but instead we're actually trying to solve the problem. that's what american people are looking for. as controversial as the efforts to reform health care have been thus far, when you ask people, should we move forward and try to reform the system, people still say yes, they still want to see change. and it strikes me that if we have got an open mind, if we're listening to each other, if we're not engaging in sort of the tit for tat and trying to score political points during the next several hours, then we might be able to make some progress. and if not, at least we will have better clarified for the american people what the debate is about. so with that, i just want to say, again, how much i appreciate everybody for participating.

and i'm going to now turn it over to senator mcconnell, so that he can make some opening remarks. and we'll just go back and forth between the democratic leaders and the republican leaders, house and senate. and then we'll just open it up and start diving in. all right? >> thank you, very much, mr. president. john boehner and i had selected mr. alexander from tennessee to make our opening framing statement. and let me turn to him. >> thanks, mitch. and john. mr. president, thank you very much for the invitation. appreciate being here. several of us were a part of the summits that you had a year ago, and so i've been asked to try to express what republicans believe about where we've gotten since then. as a former governor, i also want to try to represent governors, because they have a big stake in it. i know you met with some governors just the last few days. we believe that we -- our views represent the views of a great

number of the american people who have tried to say in every way they know how through town meetings, through surveys, elections through virginia and new jersey and massachusetts, that they oppose the health care bill that passed the senate on christmas eve. and more importantly, we want to talk about -- we believe we have a better idea. and that's to take many of the examples that you just mentioned about health care costs, make that our goal. reducing health care costs. and start over and let's go step by step toward that goal. and we would like to briefly mention -- i'll briefly mention, others will talk more about it as we go along, what those ideas are. what some of them are. of what some of the suggestions we have are. i would like to begin with a story. when i was elected governor, some of the media went up to the democratic leaders in the legislature and said, what are you going to do with this new young republican governor, a few years ago. and they said, i'm going help him. because if he succeeds, our

state succeeds. and they did that for -- that's the way we worked for eight years. but often, they had to persuade me to change my direction to get our state where it needed to go. i would like to say the same thing to you. i mean, we want you to succeed. because if you succeed, our country succeeds. but we would like respectfully to change the direction you're going on health care costs. and that's what i want to mention here the in next few minutes. i was trying to think about if there were any kind of event that this could be compared with. and i was thinking of the detroit auto show, that you had invited us out to watch you unveil the latest model that you and your engineers had created. and asked us to help sell it to the american people. and we go, and you do that. and we look at it, and we say, that's the same model we saw last year. and we didn't like it, and neither did they, because we don't think it gets us where we need to go, and we can't afford it. so as they also say in detroit, again, we think we have a better idea. your stories are a lot like the

stories i hear. when i went home for christmas after we had that 25 days of consecutive debate and voted on christmas eve on health care, a friend of mine said, i hope you'll kill that health care bill. and then before the words rattled out of his mouth, he said, but, we've got to do something about health care costs. my wife has breast cancer. she got it 11 years ago, our insurance is $2,000 a month. we couldn't afford it if our employer weren't helping us do that. so we've got to do something. and that's about -- that's where we are. but we think to do that, we have to start by taking the current bill and putting it on the shelf and starting from a clean sheet of paper. now, you have presented ideas. there's an 11-page memo on the -- i think it's important for people to understand, there's not a presidential bill. there are good suggestions and ideas on the web. we have made our ideas. but it said it's a lot like the senate bill. it has more taxes, more subsidies, more spending. so what that means is, that when it's written, it will be 2700

pages, more or less, which means it will probably have a lot of surprises in it. it means it will cut medicare by about half a trillion dollars and spend most of that on new programs, not on medicare, and making it stronger, even though it's going broke in 2015. it means there will be about a half trillion dollars of new taxes in it. it means that for millions of americans, premiums will go up. because when people pay those new taxes, premiums will go up, and they will also go up because of the government mandates. it means that from a governor's point of view, they're going to be what our democratic governor calls the mother of all unfunded mandates. nothing used to make me madder as a governor as when politicians would get together, pass a bill, take credit for it, and send me the bill to pay. and that's exactly what this does, with the expansion of medicare. and in addition, it touches 15 to 18 million low-income americans into a medicaid

program that none of us want to be a part of, because 50% of doctors won't see new patients. so it's like giving someone a ticket to a bus line where the buses only run half the time. when fully implemented, the bill would spend about $2.5 trillion a year. and it still has a sweetheart deal in it. one is out. some are still in. what's fair about taxpayers in louisiana paying less than taxpayers in tennessee? and what's fair about protecting seniors in florida and not protecting seniors in california and illinois and wyoming? so our view, with all respect, is that this is a car that can't be recalled and fixed, and that we ought to start over. but we would like to start over. when i go down to the floor, i've been there a lot on this issue. some of my democratic friends will say, well, lamar, where's the republican comprehensive bill? and i say back, well, if it you're waiting for mitch mcconnell to roll in a wheel barrow in here with a 2,700 page

republican comprehensive bill, it's not going to happen. because we have come to the conclusion we don't do comprehensive well. we have watched the comprehensive economy-wide, cap and trade. we have watched the immigration bill. we have the best senators we have got working on that in a bipartisan way. we have watched the comprehensive health care bill, and they fall of their own way. our country is too big, too complicated, to decentralized for washington. a few of us here, just to write a few rules about remaking 17% of the economy all at once. that sort of thinking works in a classroom, but it doesn't work very well in our big, complicated country. it doesn't work for most of us. and if you look around the table, and i'm sure it's true on the dimmic side, we have got shoe store owners and small business people and former county judge. and we've got three doctors. we've got people who are used to solving problems, step by step. and that's why we said 173 times on the senate floor in the last six months of last year, we

mentioned our step by step plan. for reducing health care costs. and i would like to just mention those in a sentence or two. of you mentioned mike enzi's work on the small business health care plan. that's a good start. it came up in the senate. he will explain why it covers more people, costs less. and helps small businesses offer insurance. two, helping americans buy insurance across state lines. you've mentioned that yourself. most of the governors i've talked to think that would be a good way to increase competition. number three. put an end to junk lawsuits against doctors. in it our state, half the counties pregnant women have to drive to the big city to have prenatal health care or to have their baby, because the medical malpractice suits have driven up the insurance policies so high that doctors leave the rural counties. give states incentives to lower

costs, number four. number five, expanding health savings accounts. number six, house republicans have some ideas about how my friend in tala houma can continue to afford insurance for his wife who has had breast cancer, because she has a preexisting condition, it makes it more difficult to buy @@@@@ l if we took all the problems of the health insurance companies entirely away, every skingle bit, we could pay por two days for the health insurance of americans. that would leave us with 263 days of costs that are too high. so as much as we want to expand access, we shouldn't expand a system this expensive. the best way to reduce costs and to increase -- to increase

access is to reduce costs. . . conclusion, i have a suggestion and a request for how to make this a bipartisan and truly productive session. and i hope that those who are here will agree, i've got a pretty good record of working across party lines, and of supporting the president when i believe he's right, even though other members of my party might not on that occasion. and my request is this. is before we go further today, that the democratic congressional leaders and you, mr. president, renounce this idea of going back to the congress and jamming through on a bipartisan -- i mean, on a partisan vote through a little-used process we call reconciliation. your version of the bill. you can say that this process has been used before, and that would be right. but it's never been used for anything like this.

it's not appropriate to use to it's not appropriate to use to write the rules for 17% of the economy. senator byrd, who is the constitutional historian of the senate, has said that it would be an outrage to run the health care bill through the senate like a freight train with this process. so this is the only place the senate, where the rights to the minority are protected, and sometimes, as senator byrd has said, the minority can be right. i remember reading alexis de topil's books, and he said that the greatest threat to the american democracy would be the tyranny of the majority. when republicans were trying to change the rules a few years ago, you and i were both there. senator mccain was very involved in that, about getting majority vote for judges. then senator obama said the following. "what we worry about is essentially having two chambers, the house and the senate, who

are simply majorititarian, absolute power on either side. that's just not what the founders intended." which is another way of saying that the founders intended the senate to be a place where the majority didn't rule on big issues. i mean, senator byrd and senator reid in his book, writing about the gang of 14, said that the end of the filibuster required 60 votes to pass a bill would be the end of the united states' senate. and i think that's why lyndon johnson, the '60s, passed the civil rights bill. of because he understood that by having a bipartisan bill, not only would pass it, but it would help the country accept it. senator pat manahan has said before he died that he couldn't remember a big piece of social legislation that passed that wasn't bipartisan. and after world war ii in this very house and in the room back

over here, president truman and jenmar shall would meet once a week with senator vander berg, the republican chairman of the senate foreign relations committee, and write the marshal plan. and general marshal said that sometimes van was my right hand, and sometimes he was his right hand. and we know how -- john boehner and george miller did that on no child left behind. mike enzi and ted kennedy wrote 35 bills together. you mentioned that in your opening remarks. you and i and many other others worked together on the american competes act. we know how to do that, we can do that on health care, as well. but to do that, we'll have to renounce jamming it through in a partisan way. and if we don't, then the rest of what we do today will not be relevant. the only thing bipartisan will be the opposition to the bill. and we'll be saying to the american people who -- i've tried to tell this in every way

i know how, town halls and elections and surveys, that they don't want this bill, that they would like for us to start over. so if we can do that, start over, we can write a health care bill. it means putting aside jamming it through. it means working together the way general marshal and senator vandenberg did. it means reducing health care costs and making that our goal for now, not focusing on the other goals. and it means going step by step together to reearn the trust of the american people. we would like to do that. and we appreciate the opportunity that you have given us today to say what our ideas are, and to move forward. thank you, very much. >> well, thank you, lamar. both i and lamar went a little bit over our original although indicated time. i -- do not want to be a hypocrite. wanted to give you some slack. we're going to have nancy and

harr -- owe i think me -- my understanding is you guys want to split time? >> well -- >> we'll split it up. so we'll let them -- have some quick remarks. what i will then do is just address -- john, are you going to make the presentation yourself? okay. what i will then do is just address a couple of points that were raised by you and lamar in terms of process. and then we will start diving in and getting to work. all right? nancy? >> yes, mr. president. thank you, very much, for bringing us here today. i will try to stick to the time, because we have many people to hear from. thank you, mr. president, again. it was almost a year ago, march 5th, of laugh year when you brought us together in a bipartisan way to set us on a path to lower costs, improve quality and expand access to quality health care for all americans. in the course of that time in our committees in the house and the senate, we have had lively

discussions. here we are today. you began your remarks, mr. president, by saying there was a glimmer of bipartisanship in the senate, with the passage of the jobs bill. i want you to know, there was a blaze of bipartisanship in the house yesterday with, what, 406-19, we passed, with the leadership, the lifting repealing of the exemption that insurance companies have on health insurance. and the antitrust laws for health insurance. 406-19. a very strong message that, yes, the insurance companies need to be reined in. so put us down on that side of the ledger. the -- that day, march 5th, we all remember the bipartisan spirit, the hope that was in the room. and also, when senator kennedy came into the room and declared himself a foot soldier in the

fight for health care for all americans. and then later he wrote to you and said, this is not just about the details of policy, it is about the character of our country. the character of our country has formed the backbone of our country, our working middle class families in america. as we sit around this table, i think we should be mindful of what they do when they sit around their kitchen table. at what we do here must be relevant to their lives. and for them, they don't have time for us to start over. many of them are at the end of the line with their insurance, with their caps, with their this and that. you talked about stories, senator alexander did, too. i can tell you many stories as i travel the country where i've seen grown men cry. one man in michigan, mr. denyingel, told me that his wife had been sick for a long time. he was at the end of the line in

terms of his finances. he might have to lose his home, and she was bed ridden. he was afraid of what was going to happen, and he was too proud to tell his children that he needed help. because they were raising their own families. he said, when is something going to happen on health care in if america? i can't hold out much longer. i have a letter -- michigan seems to be where i get mail from this subject, since i have traveled there recently. a woman who said that their family -- to pay their deductible, they have to subtract it from their food budget. and that's just one concern she mentioned. with that, acknowledging chairman dengle, his institutional -- how difficult it was to pass medicare, how he has worked over the decades to improve it, how committed he is to preserving it, and how important a part of preserving medicare is to this passing this

health care bill. later, he will inspire us with that. but he, mr. president, as you know, as a young congressman, gaveled medicare into law in the house of representatives. you have talked about how the present system is unsustainable for families, for businesses, large -- large, small, any size. and how it's unsustainable. as you said on march 5th of last year, health care reform is entitlement reform. our budget cannot take this upward spiral of cost. we have a moral obligation to reduce the deficit and not heap mountains of debt on to the the next generation. i want to talk for a moment about what it means to the economy. imagine an economy where people could change jobs, start businesses, become self-employed, pursue their artistic aspirations or being entrepreneurial and start new

businesses if they were not job-locked. because they have a child who is bipolar or a family member who is diabetic with a preexisting condition. and all of the other constraints that having health care or not having health care places on an entrepreneurial spirit. think of an economy with that dine minimum of people following their pursuits. taking risks. we want them to take risks. and yes we lock them down. and we have anvil around our businesses, because of these increasing costs of health care. so this bill is the no only about the health care in america, it's about jobs. and it will create 4 million jobs. 400,000 jobs almost immediately. jobs of, again, the health care industry, but in the entrepreneurial world, as well. you, mr. president, your leadership, we pass the american reinvestment and recovery act

last january and got a running start on some of the technology on scientific advancements. and investments and biomedical research, health i.t., information technology. a running start by your signing the children's health bill, insuring 11 million children. we got a running start on expanding access. of and not only that, they're doing it in a way that is of the future. this is not just about health care for america. it's about a healthier america. this legislation is about innovation. it's about prevention. it's about wellness. but most people haven't heard about that. and those peoplesitting at that kitchen table, they don't want to hear about process. they want to hear about results. they want to know what this means to them. and what it means is a health initiative that is about

affordability for the middle class, lowering costs, improving access. accessibility. affordability and accessibility are closely in line. and accountability for the insurance companies. so it is -- it's a very important initiative that we have to take. and i want to say, because medicare was mentioned, unless we pass this legislation, we cannot keep our promises on medicare. we simply must make the cuts in waste, fraud and abuse in medicare so that the benefits and the premiums are untouched. we owe it to our seniors. we owe it to our country. that day, march 5th, senator kennedy said health care is a right, not a privilege. let us move in a way -- who can say -- we started this six weeks after your inauguration. just six weeks after your inauguration on march 5th, with you extending a hand of

bipartisanship. and many of the provisions that are in our bill are initiatives put forth by republicans. others of our colleagues will talk about this. but i just hope as we sit around this table, we understand the urgency that the american people have about this issue, how to effects not only their health, but their economic security. and i thank you, mr. president, for your leadership in getting us to this place. >> mr. president, my friends in the house >> i want to spend a few moments talking about nevada, our country, and not what is going on in washington. i wanna talk about them -- a man by the name of jesus. he works in reno, nevada. he had everyt@i]g he wanted except a baby. he had health insurance, employees that like him, úqgbute

was fortunate they were going to have a baby, a little girl. the baby was born and a few ì(lc@fc.+ çñpççwerew3 told she had a clt palate. but that is okay, he was told, we could take care of that. and they did. they did surgery on the baby. he was happy -- jesusw3ç was, until he got his mail four monthst( later. the insurance company said,v: we did not realize that your baby had a pre-existing disability. we are not covering the $90,000 in hospital and doctor bills you have run out. so he is trying to pay that off. the big one -- the baby needs a couple more surgeries. this should not happen to anyone in america. he had health insurance. he paid his premiums.

i say to my friend, lamar, whom i have respect for, you are entitled to your opinions but not your own fat. -- your own facts. entitled to that, but not your own set of facts. senator monahan said that many years ago, and that's what we have to do here today. let's make sure that we talk about facts. last monday, a week ago monday, all over america, the results were run from a poll done by the kaiser foundation. it was interesting what that poll said. 58% of americans would be disappointed or angry if we did not do health care reform this year. 58%. across america, more than 60% of republicans, democrats, and independents want us to reform

the way health care works. is it any wonder. they want it so that businesses can afford health care. they want to give consumers more choices, and insurance companies more competition. and the doughnut hole. what is the doughnut hole? well, a seniorcyzen will tell you what the doughnut hole is. you can be sick and get your medication paid for for a while. of after you spent $2,000 approximately on medication, you are finished, until you spent $3,500 more out of your own pocket. and what happens during that hole that we call the doughnut hole? seniors in america are splitting pills in half. not getting their prescriptions filled. taking them every other day. again, lamar, you're entitled to your opinion, but not your own

facts. no one has said -- i read what the president has. no one has talked about reconciliation. but that's what you folks have talked about, ever since that came out. as if it's something that has never been done before. now, we, as leaders here, the speaker and i, have not talked about doing reconciliation as only way out of all this. of course it's not the only way out. but remember, since 1981, reconciliation has been used 21 times. most of it's been used by republicans, for major things. like the -- much of the contract for america. medicare reform. the tax cuts for rich people in america. so reconciliation isn't some thing that's never been done before. it's as if there is a different mind-set. a different set of facts than

the reality. remember, chairman dodd in the health committee, held weeks of mark-ups. and in the bill that he reported out of that the committee, there's more than 150 republican amendments part of that legislation. the same happened with chairman baucus in the finance committee. and those were put together and that's what we brought to the floor. so the bill on the floor that my friend lamar is lamenting here has significant input from the republicans. so let's look at the facts a little bit more. because they can be stubborn, you know? harvard just completed a study that shows 45,000 americans die every year because they don't have health insurance. almost 1,000 a week in america.

in 2008, about 750,000 bankruptcies were filed. about 70% of those bankruptcies were filed because of health care costs. 80% of the people that filed for bankruptcy because of health care costs had health insurance. america is the only country in the world where you can get sick or hurt, you're going to have to file bankruptcy. 750,000 bankruptcies in 2008. these facts show that the story that i told about jesus is not just a story about some young businessman in businessman in reno, nevada, running a restaurant that gets jerked around by an insurance company. happens all over. health reform shouldn't be about political parties fighting each other. it should be about people fighting for their lives and fighting for better quality of life.

people like jesus and that little girl. this debate shouldn't be about whether an idea came from democrats or republicans or one side of the aisle or the other side of the aisle but whether the idea will improve the health care delivery system in our country. i know it's obvious we've heard it, our republican friends oppose our legislation. and that is your right. but also it becomes your responsibility to propose ideas for making it better. so if you have a better plan for making health insurance more affordable, let's hear it. if you have a better plan for making health insurance companies more accountable, let's face it, let's work on it. if you have a better plan for doing this while cutting the deficit as our bill did during the first ten years, our bill cuts the deficit by $132 billion. the second ten years up to $1.3

trillion. those aren't my numbers. the congressional budget office. so we're ready to listen. i so appreciate the president getting us together. i want the american people to know that we need to work together. and i want to do everything that i can as a senator to work with my colleagues on both sides of the aisle to get this done. we need to do health care reform. i've spoken with madame speaker on many occasions. numerous times about health care. we spent most of the last year talking about let care. i so admire her tenacity, her legislative brilliance and i will do everything i can, mr. president to, get this health care reform over the goal line. >> well, thank you very much, harry. everybody went a little over time which is not surprising. with a room full of elected officials. i wanted to give people a little bit of why starting off but

we're going to need more disciplined moving forward if we're going to be able to cover every item. i'll try to set the example here. i just want to address very quickly lamar the issue of process you raised at the beginning and then we'll move on and start talking about the specifics. as i listened to your description of the house senate bill as well as the proposal that i put our website, obviously, there were some disagreements about how you would characterize the legislation. on the other hand, when i listened to some of the steps that you thought republicans would be open to, i thought, a bunch of these things are things that we'd like to do, and in fact, are in the legislative proposals. so part of the goal here i think is to figure out what are the areas that we do agree on, what

are the areas where we don't agree, and at end of that process, then make an honest assessment as to whether we can bridge these differences. i don't know yet whether we can. my hope is that we can, and i'm going to be very eager to hear and explore how we might be able to do so. so rather than start at the outset talking about legislative process and what's going to happen in the senate and house and this and that, what i suggest is let's talk about the substance, how we might help the american people deal with costs, coverage, insurance, these other issues and we might surprise ourselves and find out that we agree more than we disagree, and that would then help to dictate how we move forward. it may turn out on the other hand there's just too big of a gulf. and then we'll have to figure out how we proceed from there. so that would be my proposal.

and what i'd like to do then is to start first with something i heard everybody agree on. every single speaker and that was the issue of cost. it is absolutely true that if all we're doing is adding more people to a broken system, then costs will continue to skyrocket and eventually, somebody's going to be bankrupt whether it's the federal government, state governments, businesses, or individual families. so we have to deal with costs. i haven't heard anybody disagree with that. now, i've already indicated some sticks but i just want to reem fal size these. more than a quarter of small businesses have reported a premium increase of 20% or more just last year.

20%. as a consequence, a lot of small businesses have dropped coverage all together. fewer than half of businesses with fewer than ten workers now offer coverage. by one estimate, without health care reform by the end of the decade, premiums for businesses would more than double in most states. and the total cost her employee is expected to rise to more than $28,000. so you can imagine what that does to hiring, what that means for incomes and you can imagine how many families are going to be unable to afford insurance. as i mentioned earlier, i hear stories from people all the time about how these costs have very concrete impacts on their lives. i spoke to a family the linx from nashville, tennessee. they've always try dodd right with their workers but had to do the unthinkable and lay off

employees because their health care costs were too high. other business people say we were going to hire but we decided not to when we got our monthly premiums. and so one of the goals that i set out very early on in this process was how do we control costs. now, what we have done as i mentioned earlier, was to try to take an dale that is not just a democratic idea but actually is a republican idea, which is to set up exchanges. these are pools where people can come in and get the same purchasing power as members of congress do as part of the federal employees health care plan, as people who are lucky enough to work with big businesses can do because there are a lot of employees in those big businesses. what we've said is that if you join one of these exchanges, you

will have choice and you'll have competition. you will have a menu of private insurance options that you'll be able to purchase but because you're not purchasing it on your own, you're purchasing it as part of a big group, you're going to be able to get lower costs. for folks who even with those lower costs still can't afford coverage, we provide some subsidies but here's what i want to emphasize is that even without the subsidies, it's estimated by the congressional budget office that the plan we put forward would lower the costs in the individual market for the average person who's just trying to buy health insurance and they're not lucky enough to work for a big company, would lower their costs by between 14 and 20%. so, lamar, when you mentioned earlier that you said premiums go up, that's just not the case according to the congressional budget office. >> mr. president, if you're going to contradict me, i ought to have a chance to -- the congressional budget office

report says that premiums will rise in the individual market as a result of the senate bill. >> no, no. and this is an example of where we've got to get our facts straight. >> that's my point. >> well, exactly. so let me respond to what you just said, peculiar, because it's not factually accurate. here's what the congressional budget office says. the costs for families for the same type of coverage as they're currently receiving would go down 14 to 20%. what the congressional budget office says is that because now they've got a better deal, because policies are cheaper, they may choose to buy better coverage than they have right now and that might be 10 to 13% more expensive than the bad insurance that they had previously. but they didn't say that the actual premiums would be going

up. what they said was they'd be going down by 14 to 20%. i promise you, i've gone through this carefully with the congressional budget office. and i'll let me just finish, lamar. what we have done is we have tried to take every single cost containment idea that is out there, every proposal that health care economists say will reduce health care costs we have tried to adopt. -- in the the various proposals. there are additional ideas that republicans have presented that we think are interesting and we also tried to include. let me give you an example. you mentioned the idea of buying across state lines, insureds. that is something i have put in

my proposal, that is in the senate proposal. i think it shows some promise. you mentioned it that mike enzi has previously said that he is interested in small businesses being able to pool t(in the equivalent of an exchange. that is where there is some overlap. it is important to understand that what we have done is try to take every single cost- containment idea that is out there and try to adopted in this bill. what i would like to do is see if we can proceed and have a very concrete conversation about what are the ideas that you guys have that you do not think our in our bill to containç costs? çwhat i want to see is if maybe we can adopt some of those or refine what we haveç already de to further reduce costs.

>> mr. presidentd8 -- >>ç i would also like to make sure that maybe you suggest some you think are good. in your opening introduction, what i saw was the usual pacritique of what you thought it was bad. as i said, we've adopted a lot of the ideas that we've heard from your side of the aisle. so i hope maybe you could say, well, those are the ones that we think are good ideas. here are the things that we think are bad ideas as opposed to just painting in broad brush. go ahead. >> mr. president, let me show some respect for my colleagues here they're all here eager to speak. all sure they could do a better job than i could on any of these points. i would like to get back directly to you why i believe with respect you're wrong your bill would increase premiums i believe. rather than argue with you in public about it, i'd like to put

my facts down, give them to you, maybe other colleagues will say that. as far as mike enzi's proposal, he's ready to talk about it. others are. so i appreciate the opportunity that mitch and john gave pea to talk. you've made some interesting points and why not let other members of congress have a chance to talk. >> i think it's a great idea. i'd like to get this issue whether premiums are reduced before we leave today. i'm pretty certain i'm not wrong. you give us the information and we're going to be here all afternoon. i promise you we'll get this settled before the day's out. all right? mitch, who would you like to talk about cost? >> mr. president, since some liberties have been taken here, let me make a quick observation. then i'm going to call on dr. coburn to make our framing statement on the issue of cost containment. one thing i think we need to be acutely aware of, ladies and gentlemen, we are here representing the american people. >> you will you. >> and harry mentioned several polls. i think it is not irrelevant

that the american people if you average out all the polls are opposed to this bill by 55 to 37. and we know from a "usa today" gallup poll out this morning, they're opposed to using the reconciliation device, the short circuit approach that lamar referred to that would end up with only bipartisan opposition by 52-39. now, i'd like to call on dr. tom coburn who's been a practicing physician for many years to address the cost containment issue. >> mr. president, thanks for having us do this. i think today's going to be enlightening. the first thing i would do is put out a caution to us because what i see the congress doing and what i saw this last year is us actually performing bad medicine. and that is that we get stuck in the idea of treating the symptom rather than treating the disease. and what you go to harvard or

whether you go to thompson reuters, there's some facts we know about health care in america and the facts we know is one out of every $3 that gets spent doesn't help anybody get well and doesn't prevent anybody from getting sick. the second thing we know is from the congressional research service that most of the maldrivers today in health care come from government rules and regulations. the government now directs over 60% of the health care in this country. fan throwing money at it and creating new government programs could solve it, we wouldn't be sitting here today because we've done all that. it hadn't worked. so what i thought we ought to do is maybe talk about why does it cost so much? because the thing that keeps people from getting access to care in our country is cost. you mentioned malia and sasha. the fact is with young kids going to the er whether they have meningitis or asthma, they're going to get treated in this country but may get labeled with a pre-existing illness

after that that's another thing i'd be happy to talk about at later time. we know how to treat acute asthma. what we don't do a good job of is preventing children from getting acute asthma. we don't do the good job of prevention. >> uh-huh. >> soap when you break down

just on those two areas where we could cut costs 50% tomorrow. what would happen to access in this country if tomorrow, everybody's health care costs wentç down 15%. access would markedly increase. so what i would hope we would do is that we would go back and concentrate on the areas that

have the biggest pot of gold for us, and the biggest pot of gold is we do not incentivize prevention. we do not pay rewards for great management of chronic disease. we have a system throughout the country where we are encouraging lawsuits that are not productive for the country, and what they do is cause of the cost of health care to go through the roof. we also know there are other real things we should address. there are conflicts of interest within the medical field. there is nothing wrong with addressing those. we know that we do not, we absolutely do not incentivize prevention. and i am not talking about creating walking paths. i am talking about paying people who do a good job to do prevention, talk about changing the school lunch programs word needs the nutritional needs of

americans, changing the food stamp program where it incentivizes people to eat the right things. we create more diabetes through the food stamp program and school lunch than any other thing, because we are not offering, incentivizing a great response. i think it is great that we are coming toget8"abut the gold is and where is the cost excesses'? what i would hope is that we will look at that and say how we come together and actually achieve a reduction in the extortion that goes on in this country in terms of medical malpractice? there are lots of ways to do that without us mandating to the states, you have that in terms -- in terms of incentivizing states. how do we do that in terms of creating an elimination of fraud? when you compare the private sector fraud rates is 1%,

compared to medicare. -- and medicaid. there are estimates that there is a $15 billion worth of fraud in new york city alone it in medicare and medicaid. we have not gone were the money is and attacked that. my hope would be that we will look at where the money is. it is accurate -- i do not know many people that will disagree thatq $1.30 dollars will get someone well and prevent them. we need to go for that $1 in $3. we need to do that by creating an incentive to reward people. in your bill, you had from programs, but you lack -- you had fraud programs, but she lacked one thing. the biggest thing on a fraud is to have under cover pages to check on illegitimate bill. checking on whether or not this is a legitimate bill. and you don't know who's an

undercover patient and who's not. and all of a sudden, you started changing your attitude of whether or not you're going to milk medicare or you're going to milk medicaid. >> mr. president? if i could just say, i'm not an expert on much but i am filibusters. we have 40 members of congress here. >> tom, you made some powerful points. you want to wrap up real quick? >> i'll just finish with that with often out of $3 not helping everybody, we ought to go where it is. >> tom, i appreciate what you said. i think we're going to have steny hoyer go next. i want to make this quick point. every good idea that we've heard about reducing fraud and abuse in the medicare and medicaid system we've adopted in our legislation. so that's an example of where we agree. we want to eliminate fraud and abuse within the government systems. let's recognize though that

those savings in the government systems which will help taxpayers and allow us to do more doesn't account for the rising costs in the private marketplace. now, the private marketplace you mentioned the issue of medical malpractice and you know, frivolous lawsuits. as you indicated these are areas where secretary see bealious has already begun to try to give stateses incentives to do that. on the preventive side there's a whole host of provisions in the legislation passed by the house and senate. so we've identified some areas we agree on and then the question just is, does that help the average family in the individual market who potentially can get costs. but stenny, why don't you. >> let me respond to one thing. you get cost shifted every penny that gets wasted in medicare than gets cost shifted to the private sector. so if in fact we're wasting the

public sector, we're shifting it to the public sector. >> steny? >> mr. president, thank you very much. a quote i will use is we should have available an affordable health care to every american citizen to every family. i suppose there are a whole lot of every americans and american families listening to us today and watching us. and they're hoping that we're all sitting around here talking about them, not about us. that's the message they're sending to all of us. and they're absolutely correct. and we believe that we have been addressing them and trying to get some of these stories that all of us here torl a place where they won't be so tragic for individuals and for families. every one of us has a story. i had a message on my telephone answering machine just a little while ago, a couple of weeks ago. a woman that i know well called me up, she said stenny, i was just diagnosed with a tumor and

i've got to be operated on. i don't have any insurance. my husband makes $28,000, i work part time and make about $5,000. she said we're making too much money for medicaid and we're going to go to the university of maryland hospital, they want 50% down. of a $25,000 bill. she doesn't have that and we're working on that trying to get@@r -- their bill go up to, a 67% increase. they called me up and said, we do not know if we can afford to keep our small business going. all of us, john mccain, that was your quote as you recall in the debate that you had with president obama. the good thing was that both of you said the same thing. that we need to get to the objective of covering all americans and having access to

affordable health care. we agree with that. everyone or around this table agrees to it. what we will talk about is the how. cost containment is one of those issues we need to deal with, for that small business with a 67% increase, cost containment for that woman who cannot afford insurance,q but as a health care issue she cannot avoid. it is not optional for her. we have to do with that. many in my caucus believe that one way of doing that is to increase competition, toç haven open, free market that is transparent. to have an open, free market that is transparent. i think all of us around this table agree that a free market does that. an open market, a transparent market where people can compare prices and compare what they're going to get. and that's what we've tried to do in both these bills. did it a little differently but

that's what we tried to do. we hope we can get agreement on doing that, an open transparent market will bring down costs we believe and in addition to that, senator coburn, we certainly agree with you. that one in $3 is not being spent as effectively as it should be. and we have a lot of provisions in both bills as you well know that try to get to us a place where administrative costs, health information technology, so many other things are doneton wring the costs out. and in addition, you speak eloquently and correctly about wringing fraud, waste and abuse out of this system. i know you're happy to have seen in our bill in the house bill and in the senate bill very substantial investment in doing just what you suggest. so i think we have agreement on conflict of interest in delivery of medicine, as well. we've dealt with that in our bill. we've dealt with it previously

as you well know. we've put incentives for prevention in here which you mentioned. we absolutely agree on that. we think this bill does that. now you may have a better way of doing it. we need to talk about how that better way is, but we certainly have addressed the issue of making sure that we have wellness as a focus, not sickness. we have to deal with sickness but what we really want is wellness. so we've worked very hard on that in this bill. you mentioned the school lunch and food stamp programs. i'm sure we can get there too in agreement. we certainly agree with the premise you stated. what have we done? >> we've stopped premium discrimination. that clearly ups cost. if you're in a small market as the president pointed out, you're going to pail a higher price. we don't do that? why? because we're in a big market, have a competitive edge and the insurance company doesn't have pre-existing conditions for us. they take us as a group.

that's what we're trying to get for every american that they have access to a large group whether they're an individual, this woman who has the tumor or whether they're a small business, they can get into a large group. we're trying to do that. we want to go after fraud, waste and abuse. transparent market, stop premium discrimination and make sure that people with a pre-existing condition as none of us have a problem with, but a lot of people do have because we're in a big group, that are in a large group and we prohibit that. you agree with that rhetorically. now, it's not in your legislation, but you certainly agree with capping out of pocket expenses on an annual basis or lifetime basis that you don't think the that's right, that you think people ought to continue to be covered. we believe there needs to be better coordination of care. you're a doctor, you have a number of doctors in the room. we believe there ought to be a way that we can incentivize the coordination of care. we also believe there should be

incentives to provide care based upon best practices, not based upon simply procedures being reimbursed. i think we all agree on that. you're shaking your head in agreement. i know we all agree on that, and you're right. we have to get there. but i would suggest to you that one of the things that many in my caucus felt very strongly about in terms of competition was having a public option. now, there was real disagreement on that issue but many in my caucus thought that would open up competition, would provide for access for every citizen if they didn't have access in some other way. now, senator bachus is going to speak more specifically in terms of our cost containment but doughnut hole is certainly one of the issues we need to deal with. doughnut hole we deal with in our legislation in the house. we would hope that it is in legislation that we agree upon because seniors are confronted with extraordinary out of pocket

costs for a very significant portion of the cost of their prescription drugs. and seniors are concerned about that. we take care that have in our bill. but i think what the american public that's listening and watching expects us to do, mr. president is, what you're doing, bringing us together, coming to agreement to make sure that we get to a place where we reach the objective that president obama and candidate mccain expressed as the objective on behalf of the american people. thank you, mr. president. >> mr. vice president, mr. president. >> before you go, max, i just want to ask whether it's you, tom, or anybody else on the republican side and maybe some of the house members might be interested. you know it, senator coburn mentioned some cost containment issues where it sounds like we agree. fraud and abuse. we agree. it sounds like you have maybe

one other idea that you don't think is in our proposal but the idea of undercover patients but that's something that i'd be very interested in exploring. i don't think conceptually that would be a problem. the issue of prevention and that includes, by the way, things like the how our kids are eating and getting exercise. i'm proud of the first lady for working to see what she can do on that front and that's -- there are some provisions in the legislation that's already been passed through the senate and the house that directly relate to in that i think you'd be supportive of. the issue of defensive medicine, secretary sebelius is working on this but i think there are things quee do at the state level to help foster innovation and eliminate some of the concerns that you've got. i would be interested in hearing from any of our republican colleagues what objections they have to what we consider one of the biggest ways of driving down

the costs. and that's what stenny just referred to which is allowing individuals and small business who are currently trapped in a very expensive market essentially they're having to be out there fending for themselves to be able to buy into essentially a large group to become part of a large group just like all of us as government employees are part of a large group so that they have more negotiating power with the insurance companies which i think we all agree would drive down costs. if you've got some bigger purchasing power, insurance companies want more customers, they would drive down those costs. i know some of you have agreed to this as a concept in the past and so my question is, is there something in terms of the way of the house and senate bills have

been structure that had leads you to be concerned or want to not move forward on that approach? john? >> well, mr. president, i'd like to yield to mr. cline from minnesota who will talk about the small business health plans in terms of how we would propose to do this. >> thank you, leader. thank you, mr. president. i think that senator alexander framed our overall position very well when he said that we're looking at thousands of pages of legislation and we believe a better approach is to go step by step to address these issues of cost. we certainly agree that you get better economies of scale if you can come together. we have proposed in both the house and the senate, in fact, for a number of years, that small businesses be able to band together in small business health plans or association health plans. we all know and i heard everybody say here that small

businesses are the engine that drives our economy. we also know that about half of then insured either work for small businesses or depend upon somebody who does. and so we believe that we ought to address that issue by allowing these small business e to band together in the same way that large companies do. i mean really the same way so that they get all the advantages of if they self-insure, being able to avoid the 50-state mandates. being able to lower their administrative costs because they're not having to deal with that. and it will lower the cost of premiums for these small businesses and allow them to insure more people. and to keep people that are already insured on the books because we all know stories like we've heard here small businesses that are saying i can no longer provide insurance for my employees. small businesses have been

asking for this for years. it's not a new idea. they've been asking for it for years and we think it's a far better way to get these economies of scale than the exchange thing that's in the huge bill. this actually allow businesses to be able to lower their costs exactly the same way that large businesses do. it. >> okay. max is going to go and then i'll go to you, rob. max, do you want to address this issue of how we can allow people to buy into the large groups? how the senate bill accomplishes it and i don't know if you want to remark on what what john just said. >> absolutely. i'd first like to say thing is that just strikes me in spades. frankly, we all studied this issue a lot. health care reform. we basically know what the problems are, all of us. we basically know of the need, the current system is

unsustainable. we are actually quite close. there's not a lot of difference. close in the sense that without being corny or dramatic about this, if the american people want to us to do something that's basically reasonable, doesn't have to be one congressman, one senator's division, but basically reasonable, it is -- it's we are on the verge and the cusp with not too much effort to try to bridge a lot of gaps here because the gaps in my judgment are not that great. let's take the list for example that lamar mentioned. as you said, mr. president, we are basically including most of those provisions if not all in our joint legislation. selling insurance across state lines for example, we allow for that. not exactly in the way that some would but sure with, compacts and once the state exchanges are up, people would be able to buy some insurance across state lines and achieve that

competition. in addition, you mentioned lawsuits. secretary sebelius is working to try and find ways to encourage states to settle, resolve issues before they become big bad lawsuits. after that, lamar says we should find ways for states to be able to lower their costs. we do that. we let states opt out. they can do what they want to do. senator cantwell has a proposal. we give a lot of flexibility in that regard. expand hsas. that's fine. there's nothing wrong with hsas. but we also have to have products for poor people, lower income people. hsas work pretty well if you're middle or high income. pre-existing conditions clearly we all agree on that. we have those provisions in our bill. back to small business, we're not that far apart.

some suggest association health plans. where small business people can band together in an association, pool, and get better insurance. that's fine. what we provide for in our legislation is something similar. it's called the shop act. bipartisan, have worked on this. and basically it allows -- sets up a small business arrangement in exchanges. small business participates in their own exchange and gets the advantage of all the pooling. and then they can shop and compare and get a good deal. i would guess that most small businessmen like to do that. it provides tax credits for small businesses that want to purchase insurance for their employees, at 35% at the first couple of years. once the exchange's up, it is ticket%.

we -- it is 50%. we are trying to find a way for fault -- for small businesses to take the advantage of competition and shop and compare. there are also some tax provisions to encourage businesses to get health insurance. i want to say, too, if you look at all of the provisions as the steny hoyer outlined, we agreed. there are major prevention provisions in this legislation. we also agree on trying to change the way we reimburse doctors. the biggest game changer is how we reimburse our doctors, based more on quality rather than quantity. i know tom coburn it really agrees with that. he is a doctor. most doctors do. we really are close. i think once we keep pushing on those areas, we are close to making a difference.

the exchanges is a republican idea. what i like about exchanges -- it is like its m-- expedia.com. you compared and get the best price. that is basically what this is. you shop around and get your best price. çthat is going to help in my judgment. i also think that we're very hot -- hospital should publish the cost of their basic procedures, an appendectomy, a colonoscopy, to enable consumers to shop around for the best price. we all know there is a wide disparity for what hospitals charge for the same procedures. and fraud and waste, we talked about that. . . aud and waste, we talked about that. we have major provisions in our bill for fraud and waste. mr. president, in your proposal

you go even forter. >> we took additional ideas from folks like. >> they're great ideas. and unnecessary readmission rates, hospitals its. the main point is we basically agree. there's not a lot of difference here. i'd like to us kind of just -- there's an opportunity for to us work out some of these issues. >> mitch, is there somebody. >> mr. president, i'm gog yield to john here. >> i'd like to yield to dave kemp. to continue this conversation about cost containment. >> dave? >> thank you, leader boehner. thank you. thank you. thank you, leader boehner and mr. president for the invitation today. i think as we focus this part of the conversation on cost, a lot of americans say to me if you're really interested in controlling costs, maybe you shouldn't be spending a trillion dollars on health care as the senate and house bills do. also cutting medicare benefits by a half a trillion dollars to

fund this new entitlement is i think a step in the wrong direction and many americans do, as well. the nonpartisan actuaries at the center for medicare and medicaid services say on page 4 of their letter on the senate-passed bill that would bend the cost curve in the wrong direction by about a quarter of a trillion dollars. they specifically say the held expenditures under the senate bill would increase by $222 billion. a key way of reducing costs that's missing from the house and senate bills is responsible lawsuit reform that guarantees injured parties much like our two largest states have adopted, texas and california access to all economic damages such as future medical care if they need nursing care in the future, they're get it. lost wages, reasonable awards for punitive damages and pain and suffering. on page 4 of its letter to senator hatch, cbo found that this common sense reform would reduce the federal deficit by

more than $50 billion. that's just on the government side. as we know cbo doesn't score the private side on this and pricewaterhousecoopers has done a study that says savings could be as high as $239 billion if this reform were adopted. there are two features in the house and senate bills that move in the wrong direction. both bills feature restrictions on health spending accounts where people can save tax free for their health care as well as fsas, flexible spending accounts. these changes are such as they ban the use of over the count ker medication out of both of these plans. there's a new cap on fsa contributions of $2500. that will text, that language is found on page 1,0001959 of the senate bill. and that will hinder the growth of those plans. and which encourage americans to consider quality and price when they purchase health care and

let me just say under hsa plan, premiums increase just 1.3% for individuals in 2007 to 2008 and declined 5.4% for families in that same period. and when people switch from a ppo, preferred provider organization, to a health savings account, their premiums decline by an average of $3800. now, another concern i have is the senate bill which on page 982 creates an unelected board charged with recommending even more medicare reductions and if congress doesn't accept these recommendations, they have to find other medicare spending to cut instead. that give iz think too much authority to unelected bureaucrats rather than to elected representatives of the people and the power to decide whether to cut medicare and by how much. now, holding down health care costs for the government is important but i think it's also

important to hold down costs for families and employees. >> dave, i don't mean to interrupt. but we're going to have the whole section talking about deficits and we can talk about the changes in medicare. we were trying to focus on costs related to lowering families. and you know, the only concern i've got is look, if every speaker at least on one side is going through every provision and saying wa they don't like, it's going to be hard for to us see if we can arrive on agreements on things that we all agree on. i don't want to try to cut you off. please finish up but i just want to kind of point out. >> i do want to say on this issue on premiums, cbo in their letter on page 4 does say that the estimate it had average premium per person for nongroup policies would increase by 10 to 13%. >> is this the discussion i just had about lamar. >> they do say ta and they do

say that the value of the benefit is higher and that is why it goes up. but the reason the value of the benefit is higher is because of the mandates contained in the legislation, and this is one of our big concerns with a lot of the issues that have been raised. yes, we have similarities, but when all of this is structured around a government-centered exchanging that sets the standard for these policies, states can't get out of these requirements unless they take a waiver from the secretary. that kind of approach raises costs and so both of your comments were correct that costs do go up and it's because a have a richer benefit but the reason it's richer is because of the pan dates contained in these very large bills. >> i'm going to let rob, feel free to respond to everything that dave indicated or to any of the other issues that have been discussed. >> thank you. i want to thank my friend.tom coburn and jon klein for the

spirit of conversation they offered. the president asked at the beginning of this what ideas do we share about kuth costs and tom, i think you had some very good once. fraud that the president has a proposal that says we should have a database. if you've committed fraud against medicare once, you can't make a contract again. wellness, there's a lot of good ideas in the bills. junk lawsuits, i think what secretary sebelius is doing is very important in curtailing that and then the president asked the question about whether we can find agreement on pooling the purchasing power of small businesses and individuals so they can get the same deal that big companies and members of congress get. and my friend jon klein talked about the association health plan proposal. respectfully, john, i think that what you're talking about with association health plans and what we're talking about with exchanges is a semantic difference. it's a matter of pooling the purchasing power of small businesses and individuals to get a better deal but there is

one substantive difference that i want to ask about because we are concerned about it. if we can resolve this, i think we can agree. let's take the case of a woman who has a baby by c-section. and she lives in one of the many states that say you can't be kicked out of the hospital after you've had a c-section until your doctor thinks it's time for you and the baby to go home. now, under the association health plan proposal, that rule wouldn't apply to that lady and her baby. that there would be no protection of her in that situation. we think, john, that there shouldn't be necessarily, you know, 51 different rules for each state but there ought to be some minimum federal standards in these exchanges to prek people in cases like that. i the issue is if we could find a way to agree that in a case like this where a lady has a baby by c-section and has the ability to not have the

insurance company get between her and her doctor so the doctor makes the decision about when they go home, we could figure this out. how do you feel about that. >> if i could just respond to that, my friend knows very well there are large companies today who operate under what i'm proposing for association health plans. they get a waiver. they don't have to comply with the individual mandates of all 50 states. i don't hear people complaining about the insurance policies that they're getting from their big companies. >> we do. >> many of those now would you fall into what we've been calling cadillac plans because they provide very excellent service. so i think that frankly is a red herring. and i think that we can -- that you're not going to have adequate coverage on association health plans working under the same rules as large company. >> would you favor a standard that says they have to do something like that or leave it up to the insurance company? >> i would say we put the association health plans in exactly the same position that large companies are today with the same rules under erisa.

>> we don't agree with the idea that the insurance companies should get to make that kind of decision about whether the lady goes home thursday or sunday. i don't think that's intrusive. i think that makes common sense. if we could find a way to bridge that gap, then i think the ahps that you support aren't all that will different from the exchanges that we do. i think that would be a common ground. >> this has been a useful conversation. paul ryan wants to make a zmeent let me interject one quick point in terms of trying to keep everything fair. to this point, the republicans have used 24 minutes, the democrats 52 minutes. let's try to have as much balance as we can. >> i think the republican leadership are controlling the time for the republicans if i'm not mistaken. is that right. >> i don't think that's quite right. i'm just going back and forth here, mitch.

i think we're just trying to go back and forth but that's okay. paul, i was about to call on you. if that's all right. go ahead. all right. rob, here's basically wa we're looking at. the difference is this. we don't think all the answers lie in washington regulating all of this. so the problem with the approach we're see tag you're offering which i do believe senator is very different than what we're seeing is we don't want to sit in washington and mandate all you have these things. what you're doing is defining exactly what kind of health insurance people have, mandating them to buy this kind of insurance. we say look if the national restaurant association or the national federation of independent business on behalf of their members wants to set up an association health plan, we think they'll probably do a good job on behalf of their members. let them decide to do that instead of restricting insurance competition by federalizing the regulation of insurance and by mandating exactly how it will work, you make it more expensive

and you reduce the competition among insurers for people's business. we want to decentralize the system, give more power to small businesses, more power to individuals and make insurers compete more. if you federalize it and standardize it and mandate it, do you not achieve that. that's the big difference we have. >> paul, would you yield? mr. president, may i ask him to yield? >> we're not in a formal hearing here. so go ahead. >> paul, i read your and i thought one of the things you said is there should be some minimum consumer protections in the exchanges that you proposed. did i get that wrong? >> and there are in every state. what we're simply saying, look, lots of us have offered lots of different ideas. we've got dozens of republican ideas offered in the house in the bills, in the senate. many of us look at the point of the fact that the states, you know, do we distrust our governors, distrust our state legislatures? do we distrust all the state insurance? some of you may do that.

are depends who it is. but should we regulate all of this. should people in washington decide exactly how this works and what you can and can't buy. it's a difference in philosophy. >> i think this is an important point. we've got a couple other people who want to speak. we've gone about 55 minutes on this section. we're running over because we went long on the opening statements. you're right, there was an imbalance on the opening statements because i'm the president. so i made -- i didn't count my time in terms of dividing it evenly. in this section, mitch, we've gone back and forth pretty well. >> senator schumer. >> i know senator schumer wants to speak and that jim clyburn wants to say something very quickly. >> and jon kyle. >> and jon. what i want to do though is just focus in on this philosophical debate.

this is a legitimate debate. and it actually speaks to the point when i was young, just get of college, and had to buy automobile insurance with having a beat-up old car. i won't name the name of the insurance -- let's call it acme. it was in illinois. i was paying my premiums every month and after about six months of got rear-ended. i called up acme and said that would like to see about getting my car repaired. they laughed at me over the phone because really, this was set up not too rashly provide insurance. it was set up to meet the legal requirements. it really was not serious insurance. it is one thing you have an old beat-up car that you can get

fixed, but another thing if your kid is sick or you have breast cancer. fixed. it's another thing if your kid is six or you've got breast cancer. so the general idea has been here that we should set up some minimum standards within the exchange that a plan that people are buying into whether it's a small business or an individual should be at least solid enough that if your kid got sick, they're actually going to be treated. that if something happened that you weren't left with a huge bunch of out of pocket costs. it is true that you can always get cheaper insurance if it has really high deductibles or really high copayments or doesn't cover as many things. and so there has to be a balance that's struck there. i just want to point out though

that the principle of pooling at the center of both the senate and the house bill. the reason i'm pointing this out is because there was a lot of talk about government takeover of health care and the implication i think was that everybody was going to have to sign up for a government health care plan. now, that's not the issue. what the issue here which we've had an honest disagreement about is how much should government set a baseline versus just letting people decide that you know, i can't really get decent insurance but you know, maybe this is better than nothing. and that's a legitimate argument. i don't disagree with that, but i just wanted to point out when we start talking about how much government involvem is at issue here, it's not because the house or the senate bills are a government takeover of health care. it is that the house and the senate bills put in place some

regulations that restrict how insurance companies operate and if there's an exchange or a pool that's set up, that there's a baseline sort of minimum requirements that were expected. i understand there may be some philosophical differences on the other side of the aisle about that issue. chuck, go ahead. >> thank you, mr. president. i

and you see dr. smith, $4,000, and remember that he only barely waved and put his head in the door? or right now, there is some salesman talking to some doctor, and saying hey, my company will finance a machine for you for $1 million, so you do not have to pay for it. you can gradually pay. you can increase your income by $200,000. there is another machine three blocks away already working and available. these other things we need to go after. i think there are other things that we can come together on. there was a provision in the senate bill the said we ought to reward doctors for doing quality, not quantity. there are a small number of doctors -- something we have

seen already in "the new yorker" -- that a small number of people trying to maximize their and ñicome for the whole city off. maria has a provision in there that says we ought to reward doctors for the quality, not quantity. i think you can agree with it. there is a provision that senator rockefeller authored, that says 80 to 85% of what companies get money for should go to the patient. we can do all these things, but if we're going to eliminate the waste, fraud, and abuse in medicare and means we will cut gs. but it does -- but if we're going to eliminate waste, fraud and abuse in medicare, it does mean we will cut some of that out. when i hear my friend dave camp say you cannot cut money out of

medicare, well, we don't want to cut the good stuff that you point out or prevent -- the prevention but if one-third, if what senator coburn says that one-third of medicare doesn't go to patient care, you can't just get up there and say we don't want to cut anything out of medicare. we want to cut the bad stuff and keep the good stuff. and i think that's where we can find common ground, on some of the things you've mentioned, some of the things that are in our bill, and i hope at least in this area, we can move forward that way, because frankly, the republican party has always stood for getting rid of the waste, fraud and abuse in the system. in '97 it was the centerpiece of your program and all of a sudden this year, we're hearing don't do any of that. that's something that i think we can come together on. i thank you. >> mr. president, can we turn -- i'm sorry. >> we are going to go to john, then we will go to jim clyburn, then i think we will take a break because we've run out of time. >> thank you, mr. president. i think you framed the issue

very well just a moment ago because there are fundamental differences between us here that we cannot paper over. mr. president, when you said that this is a philosophical debate and it's a legitimate debate, i agree with that. we do not agree about the fundamental question of who should be mostly in charge and you identified this question as central. do you trust the states or do you trust washington, do you trust patients and doctors making the decision or do you trust washington. now, there's a mix of both, of course, in health care. but there is a big difference between our approaches and there is so much in the bills that you've supported that puts control in washington, that we have a very difficult time supporting those provisions. it's not a matter of just saying we all agree on the goal of reducing waste, fraud and abuse. we all do, of course. it's how you do it. let me give you a couple of examples. dave camp i think pointed out the answer to the dispute that you and lamar alexander had a

moment ago, and he was exactly right. let me quote from the congressional budget office letter, this is from doug elmendorf to evan bayh on november 30th, 2009. quote, cbo and joint tax committee estimate that the average premium per person covered, including dependents, for new nongroup policies, would be about 10% to 13% higher in 2016 than the average premium for nongroup coverage in the same year under current law. oliver wyman, a very respected third party group, says it's even more, about 54%. in my state of arizona, 72% increase. why is it so? for a variety of reasons, but one of which both you and dave camp agreed on. it is a richer benefit. how did it get that way? because the federal government would mandate it under your legislation in the insurance exchanges, and as a result, there would be a higher cost. how does this happen? there is an actuarial

requirement of 67% value in exchange for the least costly plan, but the average in the country today of a high dedu deductible plan is 48%. the range is 40% to 80% and the average is between 55% and 60%. so what the government is doing here is saying we're going to mandate that the insurance cover more things than it does right now and therefore, the cost is going to go up. second example. you say how can we help small businesses. well, we know one way you don't help small businesses is by raising the medicare payroll tax on them which what is this legislation does. besides that, it's a job killer. look at the taxes on beneficiaries as well. this is a third example. you don't cut costs when you raise taxes on medical devices that help us, when you raise taxes on pharmaceutical products, when you raise taxes on the insurance premiums themselves. quote, these fees on insurors, medical devices and

pharmaceuticals would increase costs for the affected firms which would be passed on to purchasers and would ultimately raise insurance premiums by a corresponding amount. congressional budget office. so when you raise these taxes, all of the different fees that are in this legislation, it inevitably raises cost on the consumer. why do you have to raise all of this money? because of the expenses of the legislation that underlie all of this. that's why republicans would rather start not by having to raise a lot of money in order to pay the high cost of this bill, but to start a piece at a time directing solutions to specific problems. that way, you don't incur all of the costs up front which require you to raise the taxes. last quick point. one of the worst things about this is for people that have catastrophic medical expenses today, after you've spent 7.5% of your adjusted gross income, you can deduct that. this bill would raise that to 10%. who does that hurt? the very people you promised, mr. president, that you wouldn't allow taxes to be raised on.

average age, 45. average income, $69,000. these are not wealthy people. just another example of why, because the bill has to raise so much money, it ends up hurting the very people that we want to help. >> okay. jon, i'm going to go to you, jim, but since, as has tended to happen here, we end up talking about criticisms of the existing bill as opposed to where we might find agreement. i feel obliged just to go through a couple of the points that you raised. just to go back to the original argument that lamar and i had and we have now chased around for quite some time, look, if i'm a self-employed person who right now can't get coverage or can only buy the equivalent of acme insurance that i had for my car, so i have some sort of high

deductible plan, it's basically not health insurance, it's house insurance. i'm going -- i'm buying that to protect me from some catastrophic situation. otherwise i'm just paying out of pocket. i don't go to the doctor, i don't get preventive care, there are a whole bunch of things i just do without, but if i get hit by a truck, maybe i don't go bankrupt. so that's what i'm purchasing right now. what the congressional budget office is saying is that if i now have the opportunity to actually buy a decent package inside the exchange, that costs me about 10% to 13% more but is actually real insurance, then there are going to be a bunch of people who take advantage of that. so yes, i'm paying 10% to 13% more because instead of buying an apple, i'm getting an orange. they're two different things. now, you can still -- you still

have an option of -- no, no, let me finish. the way that this bill is structured uses a high cost pool, a catastrophic pool, for people who can't afford to buy that better insurance, but overall for a basic package, which by the way is a lot less generous than we give ourselves in congress, so i'm amused when people say you know, let people have this not so good plan, let them have a high deductible but there would be a riot in congress if we suddenly said let's have congress have a high deductible plan, because we all think it's pretty important to provide coverage for our families, and the federal health insurance program has a minimum benefit that all of us take

advantage of, and i haven't seen any republicans or democrats in congress suddenly say you know what, we should have more choices and not have to have this minimum benefit. so what we're basically saying is we're going to do the same thing for these other folks that we do for ourselves. on the taxpayers' dime, by the way. now, there is a legitimate philosophical difference around that, but i think it's just very important for us to remember that saying there's a baseline of coverage that people should be able to get if they're participating in this big pool is not some radical idea. and it's an idea that a lot of states, you know, we were talking earlier about what states do. a lot of states already do it. this, by the way, actually, this is a republican idea that has been championed by them. we agree with the idea that

maybe if you give more regional markets and national markets as opposed to only state-by-state ones, you might get more choice and competition. that is something we find attractive. so do you guys. but the one difference as i am understand it, the reason you will not support our approach, is that we say there should be a minimum baseline benefit because if not, you get a company set up in nevada -- let's assume that there were no rules there, no projections for the woman with breast cancer, and they go into new york and offer a pretty cheap insurance to everybody who is healthy. they do not offer the same insurance to those not so healthy or with pre-existing

conditions. they drain from new york state all the help the people who are getting cheaper rates, but now everyone is left in new yorker does not qualify. they are in a pool that is sicker, older, and their premiums go up. er, older, and their premiums go up. so what we've said is if we can set a baseline, then you can have interstate competition but it's not a race to the bottom. rather, everybody's got some basic care. now, these are legitimate arguments to have. but i just want to point out that this issue of government regulation and -- which we're going to also be talking about with respect to insurance, is very different than the way this has been framed during the course of the debate over the last year, which is government takeover of insurance. this is not a government takeover of insurance. what it is is saying let's set up some baselines and then use market principles, the private

sector and pooling, in order to make sure that people get a better deal. so jim and then what we're going to do, we're just going to move on to the next topic but anybody who wants to pick up on what we've just talked about obviously can return to that as well. >> thank you very much, mr. president. mr. president, leaders and members of the congress. the two cost containment issues that i think have not been sufficiently vetted here today. let me set this up by sharing with you a conversation i had on yesterday with the administrators of the dillon or mccloud health care center in dillon, south carolina, a town you have become very familiar with. they told me that their emergency room activities have doubled over the past several years. they were looking for some

assistance to expand the size of their emergency room. when i began to question them as to why in this small county not in my district they had had such a doubling, what it turns out is that they told me that 31% of the people that they treat in that emergency room are not there for emergencies. they are there for primary care. now, this said to me that some of these people do not have health insurance, but many of them do have health insurance. but they cannot afford the $1500 to $2,000 deductibles that they would have to pay if they were to go to a private primary care provider. so they are now treating people who have got employer-based health care that they cannot

use, they are holding out for some catastrophic event but they need some assistance. now, i think that no matter what kind of plan we develop, there will be many people left uncovered and we need a safety net for those people. i believe if the one way to provide that safety net and to take care of all of those people who may be uncovered and those people who have $2,000 deductibles with primary care is for a significant expansion of community health centers. and we have not spoken about that here today, but i know that your proposal, mr. president, i know that both the house and senate plans have that in them, and i do believe that that is very, very important. we have more than a 40-year

experience with these health care centers and i do believe that no matter what we do, there ought to be a significant expansion of those health care centers. second, mr. president, a lot of other things are considered about what i have on this paper but one other thing i would like to mention, and it has to do with people who really cannot navigate the system, people who work very hard, they know what they need for themselves. but i was reminded of that when we talked about putting together restaurant owners who will design plans for their members. i would hope that when we start designing plans for the members

of small businesses, let's keep in mind that the employees of those small businesses are not negotiating these plans. they are at the mercy of the small business owners and the question is whether or not the plans are sufficient that they will not fall into the same category that these people with $1500 to $2,000 deductibles. finally, mr. president, this morning i was doing one of these call-in shows on c-span. a gentleman called in and he was very, very emotional. he said to me that he was getting ready to have transplant surgery, but he was told by the hospital that because he's on

medicare, that his post-operative treatment was going to be limited to three years. after that, he would have to find some way to pay. this man was very emotional today. what we're doing here fixes that and i do believe that we ought to really be honest with the american people when we talk about what we're doing with medicare. we're trying to make sure that medicare is there for that man and so many others who will find themselves in his position. with that, i yield back, mr. president. >> okay. i think this is actually been a very useful conversation. what i'm going to do is move on to the next topic, but maybe after we break for lunch and come back, i want to go through some areas where we decided we agreed. i know fraud and abuse is a good example. some areas where we still

disagree. one thing, jon, you shook your head when i said that people would be able to choose the better plan because the notion was well, people are mandated. actually, any insurance that you currently have would be grandfathered in so you could keep. so you could decide not to get in the exchange the better plan. i could keep my acme insurance, just a high deductible catastrophic plan. i would not be required to get the better one. if i chose to get the better one, it would be 14% to 20% cheaper than if i were going into the individual market. i just wanted to clarify that issue. >> mr. president, if i could clarify, that's for a very limited period of time, number one. secondly, the incentives are set up so that employers would drop you from their coverage because it's cheaper for them to pay the fine than to continue to pay the insurance, so they wouldn't be able to keep what they have. and third, there are still mandates in the legislation as to what you can do with what you

have such that it doesn't end up being the same coverage. so with all due respect, i disagree. it's just a fundamental disagreement between us. does washington know best about the coverage people should have, or should people have that choice themselves. pay a little less, get a little less coverage or pay a little more and get more coverage. >> can i just say that at this point, any time the question is phrased as does washington know better, i think we're kind of tipping the scales a little bit there, since we all know that everybody is angry at washington right now. i think -- so it's a good way of framing -- it's a good talking point, but it doesn't actually answer the underlying question, which is do we want to make sure that people have a baseline and this topic of insurance market reforms i think is a good additional example of what may be philosophical differences but what we may have in common. rather than go through the problem, because i think everybody understands out there the issue of people with

pre-existing conditions not being able to get insurance, people coming up with -- bumping up against lifetime caps and suddenly thinking as a family i met in colorado, they thought their child was covered, suddenly they hit the lifetime cap and they started having to scramble to figure out how they pay the additional costs. we all are familiar with these examples. i just want to go through areas where i think we agree on insurance reforms or at least some republicans and some democrats agree. i think we agree on the notion that you can't just drop somebody if they've already purchased coverage, looking at your bill, jon, the idea that you ban recissions. we agree on the idea of extending dependent coverage to a certain age. some people say up to 25, some people say up to 26, but we basically agree on that concept. we agree on no annual or

lifetime limits. we agree philosophically that we want to end the prohibition on existing conditions. i think the thing we're going to have to talk about is how do you actually accomplish that. there may be a disagreement as to whether you can do that without making sure that everybody's covered, but that's something that we can talk about. in addition, though, there are some other insurance reforms that have been proposed by the house and senate in their legislation that i think we should explore, and maybe we can narrow the gaps there and come up with some -- even a longer list of areas that we agree on. so what i do is since i want to make sure that mitch doesn't give me a time clock tally again, let me first go to mitch and i don't know who wants to make the presentation with respect to insurance reform. >> mr. president, i would like

to yield to dr. bastani to continue this conversation about insurance reform. >> thank you, mr. boehner and thank you, mr. president. i come at this as a physician, cardiovascular surgeon with over 20 years of practice doing open heart surgery, dealing with patients who have come to me with very, very challenging cases and very difficult times in their lives. along with my colleagues, dr. coburn and dr. barrasso, we bring a wealth of experience in dealing with insurance companies and all these every day problems that so many american families face. we all agree, we all agree that we need insurance reform. there's no question about it. the question is how do we do it. now, we have all been through a long year. town hall meetings, telephone calls, e-mails, it goes on and on, and one thing that has become very clear, the american people have spoken out very loudly and very clearly. they want us to take a step back and go step by step with a

common sense plan that really brings the costs down for american families and small business owners. they want insurance companies to treat them just like they treat big labor unions and large companies. it's been a resounding message we have heard over and over. so how can we achieve all this? well, we've talked about some of it. i think one of the things we ought to really look at is how do you simplify, streamline and standardize all the paperwork that's involved, because i can tell you as a doctor and my two colleagues who are physicians will know that it takes you away from patient care. it interferes with the doctor/patient relationship. it runs up cost in medical practices and it's a real issue. so i believe -- i think we can all agree on that. we need to address that issue. a second area is how do you really promote choice and competition. we have all talked about it and i think we've had a lot of

discussion already on those issues. we put forth a plan earlier in the year during the debate that actually, the congressional budget office showed that it brings down the cost of premiums up to about 10% and actually for individuals seeking -- and families seeking insurance in the individual market, those cost savings could be even higher. as opposed to the bill we have here, where we've had some discussion already and mr. camp has already outlined as well as mr. kyl that this bill would actually raise premium costs. we have talked about small business health plans. again, i ran a small business. it was a medical practice. when i wanted insurance, when those premiums were going up in double digits every year, i would call an insurance agent, they would come in, and we had very limited choice. very limited. and the costs kept going up.

where our big disagreement is, frankly, is how you do it. if you create a plan with the exchanges that are overly restrictive, it really defeats the purpose. i believe we can have faith in the american public to figure out if it is transparent enough to decide on the best deal for a small business, a family. the same for purchasing across state lines. i am glad to your democratic colleagues agree the saythis isn approach to promote choice and competition. but we feel this bill restricts those options to much. we think that we can do it responsibly. we probably could come together on this, but the existing proposals are too restrictive. health savings accounts, these are very popular among small-

business owners, families. the one impediment today is the ability to save enough in these. there are ways that we could promote these health savings accounts and real savings that will make a difference. it will not solve all the problems, but it's important for insurance reform that small important insurance y jump reform that i think small businesses will really, really jump on, if we could expand those savings opportunities. the current bill as has been stated adds some restrictions and some additional tax provisions on these which make them less palatable. we all agree on prohibiting insurance companies from arbitrarily canceling insurance policies. that's a no-brainer. there is strong agreement on both sides of the aisle there. now, with regard to pre-existing conditions, this is an issue that is very difficult and many of us and our families may have

been faced with. i can tell you i faced it when i closed my medical practice, because i had a health condition, an arthritis condition, and i went to the same insurance carrier that covered my small medical practice for 14 years, and got the big red no. can't insure you or your family. that's frankly unacceptable. now, what we propose is using risk pools, expanding these risk pools and reinsurance. it's an affordable way to do it. it creates certainty for a family that's faced with this very difficult set of circumstances. certainty is important. and our plan would not raise premium costs extravagantly, whereas the proposal here would raise those costs and it doesn't really create the kind of certainty a family needs, because there are waiting lists and that proposal is only temporary to something else that we don't know what it's going to be.

the other thing we do is we create a way for small business owners to actually shop and compare apples to apples, transparency. this is critical. our plan does this without creating the kinds of restrictions that we see with the exchange process and we agree that we have to eliminate annual lifetime caps so we have broad agreement there. again, i think it's clear the american people have rejected the bills that have gone through so far because they see increases in premiums for families, they see that it raises taxes significantly on families and raids medicare to create a new entitlement. this doesn't really bring down the cost. this is really not the answer. what american families want is a common sense step-by-step approach that will really lower the cost for families and small businesses. >> all right. >> i believe, i believe we have a duty to reform health care but

we have an obligation to get it right. >> thanks, chuck. we will go to george miller and you know, if you want to respond to specific things that charles raised or make some more general points, we'll then go back to a republican. at some point in this discussion, we're going to have to be a little more disciplined in our time in order to stay on schedule on this section, at some point i would like secretary sebelius, who is not only a former governor but also insurance commissioner, to address some of the issues that have been coming up around insurance and minimum payments. >> mr. president, i don't know if anybody was told of what the time limits are. >> well, i'm trying to be flexible. >> i'm just curious, certain amount of time in mind. >> we've got about a half hour remaining for this section. so if people can keep their -- >> thank you. >> -- points brief. frnchlg >> from the senate, we have senator harken and senator

rockefeller responding. >> i've got a list. george? >> thank you very much. this issue of insurance reform is i think where most families intersect with their insurance companies with the health security of their families. let's start out with our commonalities in the bill that congressman boehner, leader boehner, offered on the floor. he agreed that lifetime caps should be abolished, that annual caps should be abolished, that young people should be able to stay on their parents' plan to i think it was 25, i think, and your suggestion, mr. president, is 26. so there's that kind of commonality there. we think that our bill goes further and some of the suggestions you made in the interim since the house and senate passed these bills, is that clearly we think preventive care should not carry a co-pay with it. that we ought to encourage people to get that kind of preventive care for themselves, certainly for their children. we allow the health savings

accounts to continue. that's a variation my colleague talked about, what they think insurance reform should reflect. clearly now when we see the request in california for a 38% increase, in michigan for 56% increase, i think in maine it's 27% increase, you have suggested stronger language than we have in either the house or senate bill, i think along the lines with senator feinstein has been talking about in terms of rate review. people are trapped in these systems. but the one area where there still seems to be disagreement, it was not in the substitute offered by the republicans when we were on the floor, and that is this question of pre-existing conditions, because this is a real trap for families. either because you find out that you need to go to get care for a disease or illness and you may get a checkup and they may discover that you have arthritis but you didn't disclose you had

arthritis, so now that's a pre-existing condition and you may lose that policy, you may have to provide more. and the fact of the matter is, you hate to admit this at my age, but i sit here with two artificial hips, a little bit of arthritis and i have a kidney stone. i'm dead in that insurance market if i have to switch policies or switch companies or look for another chance. now, why should that be? those hip replacements have been with me for 15 years. and i have no trouble. but it's a way of denying me care. if you have acme, it's a way of denying you care. as you see from one of the blue cross companies here, there's three pages of things that will keep you out of care. will keep you from changing your jobs. and it goes on and on and on. back pain will keep you, a pre-existing condition. acne. a cleft palate.

what does that mean when you want to change jobs? what does that mean when you want to start your own company? it means you go without insurance. or you pay some policy that has a $5,000 deductible or $7,000 deductible. this is a real issue. to american families. 56 million people right now have insurance policies where pre-existing conditions can knock them out at any given time. we know that 13 million people were denied coverage over the last three years because of pre-existing conditions. so now you're trapped. you have a pre-existing condition. you can continue maybe, maybe with that insurance company, if you pay more, but you can't shop in the marketplace for another insurance company, you can't go from blue shield to kaiser because you have a pre-existing condition. you start to see the economic trap and uncertainty that families are confronted with. the interesting thing was during these negotiations, senator dodd

and i worked very hard on these issues. most of the business community signed off on getting rid of these pre-existing conditions, and i think that that's important for us to understand, that that is what real insurance reforms are. should you still be able to charge women more than men, should you rate based upon gender, to what extent can you rate based upon ages, where do you -- what's the essential benefit that we're providing. we can all describe that plan that's really inexpensive that just doesn't have many benefits that go with it for families, and so i think that this is a very important part of this discussion. i know when i go home in my district, i hear about this from the people i represent, i hear about this from my wife, she's talking about our kids and her friends and people she spends time with, how they struggle with these. and what we're really talking about is the manipulation to

move people around within the insurance market and yes, you can go to a high risk pool, so yes, because you have a pre-existing condition, because i have two artificial hips, i can go to the most expensive insurance system in the country. i'm now in a high risk pool and i'm trapped in that high risk pool forever. you can make it a high risk pool among states, you can make it a high risk pool among small businesses, you can make it a high risk pool among large businesses, i'm still trapped in the most expensive insurance because of something that happened to me that i had no control over. i have a child with a cleft palate. i have a child with acne. how can this possibly be? now fortunately, in our discussions as i said, a lot of the business organizations have agreed that these things should be phased out over time. some could be put in right away, it is' not terribly expensive to cover people 18 to 26 and that can be done right away and we have that commonality.

so i would just hope that we would focus on this issue of what real insurance reform looks like with respect to the impacts on families and individuals as they try to navigate this insurance market. >> thank you, george. >> thank you, mr. president, for doing this. i understand the four categories but there's a big category that the people in my state and across this country are deeply concerned about. that's not just the product that we are examining today, the 2,400 pages, but the process we've gone through to reach that. now, both of us during the campaign promised change in washington. in fact, eight times you said that negotiations on health care reform would be conducted with the c-span cameras. i'm glad more than a year later, that they are here. unfortunately, this product was not produced in that fashion.

it was produced behind closed doors, it was produced with unsavory, i say that with respect, deal-making. the louisiana purchase funding of $300 million for one state, the cornhusker kickback which is, i understand now, been done away with. one of the things that, provisions of this legislation that was particularly offensive was the carve-out for 800,000 florida seniors exempt from cuts in medicare advantage program. there's 330,000 seniors under medicare advantage in my home state of arizona. they're deeply concerned about that. they're deeply concerned about the carve-outs for vermont, massachusetts, hawaii, michigan,

connecticut. $100 million for a hospital in connecticut. why should that happen? they don't understand it. and at the town hall meetings that i conduct all over my state, people are angry. we promised them change in washington, and what we got was a process that you and i both said we would change in washington. so then we got into the special interests, whether it be the hospital association or the ama or others, and one of them that was particularly egregious, i won't go through the whole list, was phrma. phrma got an $80 billion deal and in return for which they ran $150 million worth of ads in favor of quote, health reform. there are over $2 million a year

lobbyist was here at the white house and was reported to say in the media a deal is a deal. part of that deal was that there would not be competition amongst pharmaceutical companies for medicare patients. the other, among others, was that the administration would oppose drug reimportation from canada, a proposal that you supported in the united states senate. >> john, can i just say -- >> can i just finish, please? and then at christmas day, i believe it was at christmas, the majority leader said quote, a number of states are treated differently than other states. that's what legislation is all about. that's compro when my constituents who overwhelmingly reject this proposal s